The Holiday Period Has Seen Some Pretty Dodgy Documents Released When We Were All Distracted.

The following appeared just before Christmas.

http://www.safetyandquality.gov.au/our-work/safety-in-e-health/

Safety in E-Health

E-Health programs have the aim of improving the quality of health care. The main elements of Commission”s Safety in E-Health program are:

• Optimising safety and quality within the rollouts of clinical systems, with an initial focus on discharge summary and hospital medications management programs
• Using E-Health initiatives to improve the safety and quality of health care
• The secondary use of information agenda – optimising reuse and analyses of safety and quality data available from clinical systems, to further drive improvements in safety and quality

The Commission works in collaboration with jurisdictions, the private hospital and primary care sectors, NEHTA, the National Health CIO Forum, and other national bodies to promote the safety and quality agenda within national E-Health programs. Five E-Health projects are reported here:
The last one was this:

Clinical safety audit program for the Personally Controlled Electronic Health Record (PCEHR)

The Commission has established an independent Clinical Governance Advisory Group (CGAG) and a clinical safety audit program for the Personally Controlled Electronic Health Record (PCEHR).

This national clinical governance function complements and strengthens the work being performed by the National E-Health Transition Authority in assuring the safety and quality of the standards and specifications supporting the PCEHR and will provide external assurance on PCEHR clinical safety issues.

The CGAG meets quarterly to consider the clinical safety audits of the PCEHR and other clinical safety issues relating to the PCEHR and provide advice to the Department of Health and Ageing. The CGAG comprises experts from across Australia, and is chaired by the Chief Medical Officer Professor Chris Baggoley.

• First PCEHR Clinical Safety Audit (PDF 838KB) (Word 154KB)
• Second PCEHR Clincal Safety Audit (PDF 785KB) (Word 138KB)
• Third PCEHR Clinical Safety Audit (PDF 539KB) (Word 93KB)
• Review 1: Status report on Recommendations (PDF 17KB) (Word 25KB)
• Review 2: Status report on Recommendations (PDF 138KB) (Word 25KB)
• Review 3: Status report on Recommendations (PDF 184KB) (Word 25KB)

The documents are all dated some time in December 2014 - but were actually created during 2013 - and have clearly been kept secret for over a year.

There were 3 Audits of the Clinical Safety of the PCEHR (February, June and December 2013) and interestingly the first two were done by KPMG and the third was done by PWC.

Also it is notable that all three reports are 10-15 page summaries not the full reports.

This few paragraphs show just how much progress has been made - or not.

“The Third Clinical Safety Review of the Personally Controlled Electronic Health Record (the Third Review) was conducted in the period October to December 2013.

The key findings and recommendations presented in this report are based on the analysis of the qualitative and quantitative data collected throughout the audit across the three key review areas.

Within the three key review areas there were a total of 15 findings. The findings have been classified according to the risk ratings developed for the first two audits (a rating scale of critical, major, moderate, minor, minimum). Within the three key review areas there were 1 Critical, 4 Major, 6 Moderate, 2 Minor and 3 Minimum findings. The findings have been classified according to the risk ratings developed for the first and second audits. The 15 key findings resulted in 15 recommendations for consideration. The key findings and recommendations are detailed below.”

So after 2 audits and responses to them we still have extant 1 critical and 4 major issues outstanding.

No information is provided for 2014 so we have no idea what the present status us.

Reading the reports and the responses is it clear there is no properly developed clinical incident reporting system for the PCEHR and that, at the same time there are real issues.

Contrast this with what is reported regarding the UK National E-Health Program:

Clinical safety of England's national program for IT: a retrospective analysis of all reported safety events 2005 to 2011

Farah Magrabi , Maureen Baker, Ipsita Sinha, Mei-Sing Ong, Stuart Harrison, Michael R. Kidd, William B. Runciman, Enrico Coiera

Received: March 26, 2014; Received in revised form: September 15, 2014; Accepted: December 28, 2014; Published Online: January 03, 2015

DOI: http://dx.doi.org/10.1016/j.ijmedinf.2014.12.003

Publication stage: In Press Accepted Manuscript

Highlights

• All known safety problems with national scale IT systems in England were examined.
• National IT implementation was associated with problems on a large scale impacting on care delivery.
• Problems encountered are not unique, but are well-understood challenges of IT implementation.
• Human factors were four times as likely to result in reported patient harm than technical problems.

Abstract:

Objective

To analyse patient safety events associated with England's national program for IT (NPfIT).

Methods

Retrospective analysis of all safety events managed by a dedicated IT safety team between September 2005 and November 2011 was undertaken. Events were reviewed against an existing classification for problems associated with IT. The proportion of reported events per problem type, consequences, source of report, resolution within 24 hours, time of day and day of week were examined. Sub-group analyses were undertaken for events involving patient harm and those that occurred on a large scale.

Results

Of the 850 events analysed, 68% (n = 574) described potentially hazardous circumstances, 24% (n = 205) had an observable impact on care delivery, 4% (n = 36) were a near miss, and 3% (n = 22) were associated with patient harm, including three deaths (0·35%). Eleven events did not have a noticeable consequence (1%) and two were complaints. (More details at site on statistics)

Conclusion

Events associated with NPfIT reinforce that the use of IT does create hazardous circumstances and can lead to patient harm or death. Large-scale patient safety events are a new phenomenon that have the potential to affect many patients and clinicians, and this suggests that addressing them should be a priority for all major IT implementations.

Here is the link:

http://www.ijmijournal.com/article/S1386-5056%2814%2900248-2/abstract

There is little doubt those responsible for the PCEHR simply failed in their duty to institute a proper Clinical Safety Monitoring System from Day 1, have no idea what is going on presently and that this omission is recognised as bad enough that what limited information has been created is being kept secret for as long as possible.

This is a travesty of mismanagement and incompetence in my view. You really need to read the documents to see what an obfuscatory and ignorant joke they are!

David.